among Londoners. Their report stands first in
the appendix to Mr. Simon's Blue Book, which
contains first, in about eighty pages, his own
generalisation of and comment upon the results
of the year's inquiries, and then in seven hundred
pages an appendix formed of the original reports
of the skilled inspectors who were directed to
inquire into the different matters chosen this
year as the special subjects of investigation.

A statistical return of the Registrar-General's,
lately printed, shows that while in forty-four
of the six hundred and twenty-seven registration
districts of England, there were in ten
years no deaths from small-pox among children
under five years old, other districts varied much
in the rate of mortality proportioned to the
neglect of vaccination. In Shrewsbury the
mortality from small-pox among young children
forms more than a ninth part of the deaths from
all causes; in Northampton and Plymouth about
an eighth part, and in Merthyr Tydfil as much
as a sixth! It is shown that these variations are
dependent on the state of public vaccination.
Thus, from their elaborate examination of the
state of children in the London Vaccination
district, Doctors Seaton and Buchanan find that
there is, from several causes, failure to a great
extent by actual neglect of vaccination, varying
in degree in different districts, and by vaccination
inefficiently performed. Of those vaccinated
only a third part have obtained the high degree
of protection furnished by the production of
four good sized vesicles. The hands of particular
good or bad vaccinators could be clearly traced
by the scars on the arms of the school children.
Thus we are told that the vaccination of Mr.
Guazzaroni could be recognised by its conspicuous
excellence, in any school in Kensington,
and that "some very fine vaccine scars were seen
in Lambeth Infant School, the work of Doctor
Smyth." So it is not only in works from the
desk or the easel that a good critic recognises
and admires the distinctive artist hand. Of a
thousand children who showed on their arms
the trace of a vaccinating master-hand, the
proportion that were also pitted by small-
pox, was but one and a quarter; of those
showing good scars, the proportion was two
and a half; of those who had been ill vaccinated,
this proportion in the thousand was seven and
a half; but of those who had not been
vaccinated at all, the proportion in the thousand
was three hundred and sixty! So that while
thoroughly good vaccination, indicated by the
production of four perfect vesicles, is thirty
times safer than bad vaccination; even bad
vaccination is fifty times safer, and moderately
good vaccination is two hundred times safer,
than no vaccination at all.

Efficient public vaccination is most surely
obtained when the vaccination stations are
convenient for the population they are meant to
serve, are carefully dissociated by the parishes
from the whole machinery of poor relief, and
are open only on one day in the week. What
is wanted is a continuous course of arm to arm
vaccination, and this is only to be secured where
the vaccinator operates on about five hundred
cases in the year, and brings most of them
together at fixed intervals. As for the connexion
between public vaccination and the parish doctor,
it simply hunts the public from the vaccinators'
doors. In Deptford and Woolwich, one of the
public vaccinators was the parish surgeon, who
vaccinated in his surgery at the hours fixed for
attendance of the pauper cases of sickness. This
was resented by the independent poor, who sent
nearly all their children to the vaccinator who
had no parish appointment. In St. George's-
in-the-East many parents refused to allow their
children to be touched by the public
vaccinator himself, who was also the parish surgeon,
but went readily to the surgery of his deputy,
who had no parish appointment. Practising
upon this feeling, the parish authorities of St.
Giles's, who thought it desirable to force as
many as they could into the hands of private
vaccinators, opened no other public vaccinating
station than the workhouse and some adjacent
premises used for parish purposes. Inquiry
shows that public vaccination is, on the whole,
decidedly more efficient than that by private
practitioners, who are but occasionally called
upon to operate. It is desirable, therefore, to
encourage to the utmost, instead of discouraging,
the use of the vaccinating stations legally
established, and to disconnect from them utterly
whatever can suggest the notion that the use of
them is a receipt of the grudged parish alms.

These questions concerning vaccination have
been especially forced on attention by the
epidemic of small-pox in London, which began at
the east end of the town in the middle of the
year 'sixty-two, kept pretty much north of the
Thames, and was at its height in the second
quarter of the year 'sixty-three. The number
of deaths was considerably more than two
thousand above the average. Still, in the severest
epidemic London has seen for the last twenty
years, the deaths in a year from small-pox among
each hundred thousand of the population have
been only seventy-one, the average but ten;
while a century and a half ago the average was
a hundred and fifty, and the rate of mortality of
some years among each hundred thousand was
four hundred and seventy.

To get rid of small-pox altogether, nothing is
wanted but a complete and effective system of
public vaccination. Within half a mile of every
house there might be a vaccine station for a
district large enough and well enough frequented
to provide, at its fixed hours, a certainty to every
mother taking her child thither, of finding at the
right time, the right man ready to do his work
in the right way, and fresh lymph for him to
work with. There should be fifty or sixty
stations and no more, under the regulation of an
independent committee, exercising all the
functions now exercised in this matter by thirty-nine
separate authorities, and there should be an
effective register and law to compel parents to
have their children rightly vaccinated.

The next subject of inquiry in the Health
Officer's Budget is the sort of support given to